[Hiring] Provider Relations Representative @TruHealth

Role Description

The purpose of this position is to analyze assigned existing market needs, perform some standard contracting functions, educate providers and provider service entities, maintain business relationships for the Health Plan(s), report on provider and market changes, and act as a support for other service areas for the Health Plan(s).

Essential Functions

• Contracting providers and essential vendors in current service areas to maintain CMS adequacy and provide necessary services in the care of the Plan members.
• Ensuring providers and essential vendors in current service areas meet the credentialing requirements for their appropriate service lines.
• Educating providers on the Health Plan(s) functions and roles in caring for its membership.
• Ongoing educational updates as prescribed by CMS and the Health Plan(s) policies.
• Conducting education presentations of the Health Plan(s) providers to ensure their understanding and commitment to the Health Plan(s).
• Monitoring, maintaining, and supporting provider relationships to ensure network coverage in all areas.
• Working with and being involved in implementation as needed.
• Establishing a positive work environment that encourages participation in process improvement and commitment to department/company success.
• Completing corporate assignments as assigned.

Qualifications

• Must be fluent in all current provider payment methodologies including per diems, DRGs, and APCs.
• Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships.
• Must be able to accept instructions and work independently in the completion of goals and assignments.
• Must have strong negotiation, organization, presentation, and time management skills.
• Must be able to effectively communicate with all levels of medical staff to explain Health Plan(s) program, benefits, and goals.
• Must be able to work effectively in a team environment.
• Excellent computer skills, including Microsoft Office Suite.
• Must be self-motivated, dependable, team and goal-oriented.

Requirements

• Experience in the health care field required.
• Prior experience in network development/network services is preferred.
• Prior experience with acute and post-acute facilities is beneficial.
• Prior experience with Medicare Advantage plans is helpful.

Licensing/Certification/Education Requirements

• Bachelor’s degree, with emphasis in Healthcare Administration/related field or three (3) years of experience in managed care network development/network services.

Other Requirements

• Must be available to work 8 a.m. until 5 p.m. local time.
• Position requires travel to network provider locations.
• Teleworking is an option if criteria are met.

Benefits

• Affordable Medical/Dental/Vision insurance options.
• Generous paid time-off program and paid holidays for full-time staff.
• TeleDoc 24/7/365 access to doctors.
• Optional short- and long-term disability plans.
• Employee Assistance Plan (EAP).
• 401K retirement accounts.
• Employee Referral Bonus Program.

Equal Opportunity Employer

Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.

This employer participates in E-Verify.